Assessing alcohol versus baclofen withdrawal syndrome in patients treated with baclofen for alcohol use disorder

J Clin Psychopharmacol. 2014 Feb;34(1):153-6. doi: 10.1097/JCP.0000000000000054.

Abstract

Baclofen is a γ-aminobutyric acid B (GABA-B) receptor agonist that is approved for spasticity. Recently, the off-label use of baclofen for alcohol use disorder (AUD) has increased. However, baclofen is known to induce a neuroadaptation process, which may be identified by the occurrence of a specific baclofen withdrawal syndrome (BWS), that is, confusion, agitation, seizures, and delirium. The same set of symptoms characterizes alcohol withdrawal syndrome (AWS), which could lead to mistaking BWS for AWS in some situations. We report the cases of 3 patients under a chronic baclofen treatment for AUD. The patients emergently presented with a clinical state of confusion that was initially diagnosed and treated as AWS, with limited effect of benzodiazepines. Retrospectively, using a validated algorithm for assessing drug-induced withdrawal, we determined that all of these clinical cases were consistent with BWS. Both AWS and BWS should be considered in the case of acute confusion or delirium occurring in patients treated with baclofen for AUD. Moreover, further research should investigate to what extent GABA-A and GABA-B induce shared or distinct neuroadaptation processes and withdrawal syndromes.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Alcohol Abstinence*
  • Alcohol Drinking / prevention & control*
  • Alcohol Withdrawal Delirium / diagnosis
  • Alcohol Withdrawal Delirium / drug therapy*
  • Alcohol Withdrawal Delirium / etiology
  • Alcohol Withdrawal Delirium / psychology
  • Alcoholism / diagnosis
  • Alcoholism / psychology
  • Alcoholism / therapy*
  • Baclofen / adverse effects*
  • Confusion / chemically induced
  • Delirium / chemically induced
  • Diagnosis, Differential
  • GABA-B Receptor Agonists / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Off-Label Use
  • Predictive Value of Tests
  • Risk Factors
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / etiology*
  • Substance Withdrawal Syndrome / psychology

Substances

  • GABA-B Receptor Agonists
  • Baclofen